Performance of MAGGIC score in African Americans compared to whites

Background: Risk stratification is critical in Heart Failure (HF) care. The MAGGIC score is a validated tool derived from a large multi-study cohort of nearly 40,000 but very few of the patients self-identified as Black or of African Ancestry (less than 400). There is little data assessing MAGGIC score utility in African Americans (AA). Methods: This single center study analyzed a total of 4264 patients from 2 cohorts; one utilizing administrative data from hospital discharges for HF (January 1 st , 2014 through July 30 th , 2015, n = 2503) and a prospective registry of ambulatory HF patients (n = 1761), both based in southeast Michigan. Baseline characteristics were collected to tabulate MAGGIC score and test its risk stratification in self-identified African Americans (AA) and whites. The primary endpoint was time to all-cause mortality. Death was detected using system records and the social security death master file. Cox models with MAGGIC score as the only variable stratified by race, and a combined model including MAGGIC, race, and MAGGIC*race were tested. P \u3c .05 was considered significant. Results: Overall, 1748 patients (41%) were AA, and a total of 1151 (27%) patients died during follow up. MAGGIC score was strongly and similarly predictive of survival in both race groups. Among AA, each MAGGIC point carried HR of 1.12 (95%CI 1.10, 1.14; P \u3c .001) while in whites the HR was 1.13 (95%CI 1.12, 1.14; P \u3c .001). Formal test of interaction of MAGGIC by race was not significant ( P = .153). However, there was a difference in survival by race, with African Americans showing a survival advantage (HR = 0.72, P = .001) which appears to be isolated to the highest risk subgroup (Figure). Conclusion: These data support the utility of the MAGGIC score for risk stratification in African Americans who suffer from HF. However, there may still be residual differences in outcomes between AA and whites despite overall risk adjustment, particularly in highest risk subgroup